A retrospective study of seven cases of Candida parapsilosis peritonitis in CAPD patients: The therapeutic implications

Background: Candida peritonitis accounts for the majority of fungal periton itis in continuous ambulatory peritoneal dialysis (CAPD), but the Candida s pecies were not routinely subtyped in previous studies. The clinical course and the outcome of Candida parapsilosis peritonitis remain unclear Objective:To study the clinical course and outcome of C. parapsilosis perit onitis in CAPD patients. Setting: Peritoneal dialysis unit in a regional hospital. Patients and Design: A retrospective study on seven cases of C. parapsilosi s peritonitis occurring in a single center over 3 years. Results:The 7 patients included 4 males and 3 females. Their mean age was 6 2 +/- 11.5 years. Two (29%) were diabetic. Three (43%) had a history of pre ceding peritonitis and 5 (71%) had received broad spectrum antibiotic withi n the previous I month. All presented with cloudy dialysate, abdominal pain , and fever. The mean dialysate white cell count was 300 +/- 168/mm(3) with a predominance of neutrophils (81.4% +/- 13.1%). The mean time from onset of symptoms to diagnosis was 5.7 +/- 3.1 days. All had been treated with im mediate catheter removal within 24 hours of diagnosis and antifungal therap y, including oral fluconazole, intravenous (IV) amphotericin, or their sequ ential combination. Environmental samplings were negative for C. parapsilos is. The overall complication rate was exceptionally high (71%), with three (43%) complicated by abscess formation requiring surgical drainage, one per itoneal adhesion (14%), and one mortality (14%). In the end, only two (29%) could resume CAPD. Conclusions: The outcome of this study group appeared worse than those prev iously described in the literature, and the optimal treatment for this grou p of patients remains unclear.